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HomeMy WebLinkAboutSEP2014-00056raw -�it 4. Jefferson County Department of Community Development �o *,it 621 Sheridan St,Port Townsend WA 98368,(360)379-4450 t.m SEPTIC PERMIT APPLICATION s A �`,>, , , PROPERTY OWNER ©s E1 1)1 BE)E 'r a '"51oo2s9 ..0�, MAILING ADDRESS ' • : O. :1■1 �- L ERICSEN.. 1, PHONE ( 3420 ) 4 q tt g 3 S '' *r `' I 3-9'/ SYSTEM DESIGNER ER t C. E N -DES I Designer Phone# 3420 - 301 i -0 3424- LEGAL DESCRIPTION: Section It Township 30k) Range .11J PARCEL# q 3 8 T 00 8(2.1 Subdivision Name� e � �& C- l.0 N Y Division :I, Block Fj Lot(s) 2_ ' .q Site address/Directions to site i i 6 . 'PA LM ER DR, ?UR T To u)O sE Mb ,e SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE 1-3,_ Residential )C New Tank/s only Private Residential ADU Modification Public A Commercial Expansion Community Upgrade Repair )(( SITE SIZE I d� 0D° So* SYSTEM TYPE Partial Repair-(tank) „ (drainfield) Previous Evaluation Conventional 14 Designate Reserve Area Yes# SD t'1 17-33 Alternative Redesign No SYSTEM DETAILS Number of Gallons/day e X. d 40 Soil type (attach soil eval_) Application Rate qal./sq.ft./day Drainfield Length E)C. ft Trench Width £)C. ft. Trench/Bed Depth (7( in. Septic Tank size 1 000 gal_ Pump Chamber size gal. TYPE of system_ TA N K ETC-A C_ /EN T By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she requires prior notice. Inspections shall occur during regular business hours. Initial here if you require notification before entry Appeal—A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in writing within fifteen days after receiving written notice of the decision. DISCLAIMER This application is for an on-site sewage system that meets the state and county standards in effect on the date of application. This application for an onsite sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. Property Owner Signature Date FOR OFFICE USE ONLY p�y,yA �/M ' •7) NC�W' f CY'f��( ,4 , 1 ii /!T FIN / I � PARTIAL ASBUILT `1 APPRO :* -44.1'‘; I& 1/a�i/ 1 INSP/PUMP TEST YCQ ALL HOLD REQ.MET Date 51/2-114 Fee , 2�6 Rec# /C(, 33b Check# Z 5 Xs Case#SEP 1(4--6C)519 H:\WEB\PDFs\Septic\septic_permitapp_2008.DOC ■ SON JEFFERSON COUNTY PUBLIC HEALTH g 615 Sheridan Street •Port Townsend•Washington •98368 www.jefferson countyp ub lichealth.o rg I'hone 360-ibb-9444 I-ax 36u-3/9-4481 ON-SITE SEWAGE DISPOSAL PERMIT PERMIT#: SEP14-00056 Date Received: 05/12/14 Date Issued: 06/19/14 SITE ADDRESS: 170 N PALMER DR Date Expires: 09/19/14 PORT TOWNSEND, WA 98368 APPLICANT: JOSEPH T DIBENE PHONE: 170 N PALMER DR PORT TOWNSEND WA 983689490 LEGAL DESCRIPTION: CAPE GEORGE COLONY DIV 3 BLK 8 LOT 22 PARCEL#: 938400821 Section: 12 Township: 30N Range: 02 W DESIGNER: BERNT ERICSEN PHONE: 360-301-0324 293 PINECREST DRIVE PORT TOWNSEND WA 98368 SYSTEM DESCRIPTION: SEPTIC TANK TO IND SYS No. of Gallons per Day: 240 Type of work: REP Drainfield Trench Septic Tank Length: feet Width: feet Depth: inches Size: 1,000 gallons DISCLAIMER-This approval is for an on-site sewage system that meets the state and county standards in effect on the date of application. This approval for an on-site sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. All construction and development activities must comply with all permit conditions,state and local codes, and Recommended Standards and Guidance documents in effect when the permit is issued. The property owner is responsible for the accurate location of all property lines.Any removal of or major disturbance of soil in the primary or reserve drainfield area may create site conditions that are unacceptable for the installation of a sewage disposal system. Any change in drainfield or tank location may invalidate this permit unless prior approval is obtained from the Jefferson County Environmental Health Division. If during excavation or development of the site an area of potential archeological significance is uncovered, all activity in the immediate area shall be halted,and the UDC Administrator shall be notified at once. Permit issued to CONSTRUCT, ALTER, REPAIR OR MODIFY AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM IN JEFFERSON COUNTY, WASHINGTON This permit is issued for a period of three years (unless otherwise stated above) in accordance with Jefferson County Rules and Regulations for On-Site Sewage Systems, codified in JCC 8.15 as amended. This permit may not be renewed. Jefferson County Environmental Health Specialist This permit with conditions must be onsite during all phases of construction HEALTH DEPARTMENT MUST BE CONTACTED FOR FINAL INSPECTION. SPECIAL CONDITIONS APPLY - SEE ADDITIONAL PAGES CONDITIONS OF APPROVAL - PERMIT NO.: SEP14-00056 1.) This permit was issued to correct a violation of WAC 246-272A for a leaking tank. The permit must be completed within 90 days of the date of issuance. 2.) The tank location must be 5' minimum from the property line 3.) NO RESERVE DRAINFIELD AREA WAS IDENTIFIED DURING THIS TANK REPAIR PERMIT APPLICATION. PRIOR TO FUTURE BUILDING PERMITTING ON THIS PROPERTY, AN APPLICATION FORA RESERVE DRAINFIELD, LOCATED BYA SEPTIC SYSTEM DESIGNER WILL BE REQUIRED. 4.) H - Existing tank shall be properly abandoned. It shall be pumped and filled with clean fill. Documentation to be provided to Health Dept. prior to final. 5.) Notification of the start of construction shall be faxed or emailed to Jefferson County Public Health ONE WORKING DAY prior to start. 6.) H - AS PER WAC 246-272AAND JEFFERSON COUNTY CODE 8.15 ALL ONSITE SEWAGE SYSTEMS REQUIRE THAT A RESTRICTIVE COVENANT REGARDING THE MONITORING OF THE ONSITE SEPTIC SYSTEM BE RECORDED TO THE PROPERTY TITLE. THE PROPERTY OWNER SHALL ASSURE THAT MONITORING IS PROVIDED BY AN APPROVED ENTITY AT THE FREQUENCY DEFINED PER STATE WAC 246-272A AND JEFFERSON COUNTY CODE 8.15 AS ADOPTED OR AMENDED. A COPY OF THE RECORDED OPERATIONS AND MONITORING AGREEMENT IS REQUIRED PRIOR TO FINAL APPROVAL OF THE SEWAGE DISPOSAL PERMIT 7.) H -An asbuilt drawing and certification of completion by the Designer is required prior to final approval. 8.) Designer must be contacted prior to start of construction and for inspections during installation. DESIGNER IS REQUIRED TO DO A PRECOVER INSPECTION ON ALL TYPES OF SYSTEMS. 9.) Before final approval is given, the designer shall provide an operations and maintenance manual to the property owner and the Health Department. The manual must instruct the owner of the on site sewage system on the ways to properly operate and maintain all components of the system. 10.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area. 11.) Approval/issuance of a sewage disposal permit does not guarantee the approval of other development or a building permit on this site. Compliance with other Jefferson County and Washington State Codes is required. 12.) All construction and development activities must comply with all permit conditions, Washington State and Jefferson County Codes and Recommended Standards and Guidance documents in effect when the permit is issued. 13.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Unified Development Code for other/future development on the site. 14.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. SEP14-00056 Page 2 of 2 \\tidemark\data\forms\F_SEP_Permitmod.rpt 6/19/2014 it ' CONVENTIONAL SYSTEM ASBUILT INSPECTION REPORT INSTALLER Ousel.) ( Ttrt THOtiAs-) PARCEL# q3g 4C0 gii JUL 2 9 2014 Permit Owner J 05 EP H T BEN E Permit # S El' 14 - S(o ABSORPTION AREA: DRAINFIELD TRENCH TRENCH TANK #OF #GAL/ LENGTH WIDTH DEPTH SIZE /000 BEDRMS a DAY .2 440 Tank Shroud/ _ IF PUMP AND PUMP CHAMBER REQUIRED: Size Screen Float Arrangement High water float—distance to top of tank/emergency storage — Dose drawdown (#of inches) #Gallons/Dose — Timer/Dose Counter info -- Pump Size!Manufacturer I CERTIFY THIS ONSITE SEWAGX SYSTEM AS INSTALLED AS DESIGNED,PER PLAN APPROVED 6-1g- I4 � 'r, i- 1$ -!4 DATE APPROVED tzsufnee SIGNATURE DATE $EE A TTE}GRED RECORD -MAW'IJC-I TAt■ WATER. TESTED 1- 11-04. Mqy rr- c, .. ‘ti 1 2204 u,� = ,, y G 0z4 sr > ` ` 0 � „.,;14, �► ,0:.cog `,.t: Gt"Vt1"#‘ 11601 1 4, s....ms ,. that",c...,>....... - f Cl) y_ NO / Qa° N. Palmer ; :.: ,� '.... i Pavement -<— <—<—<—<— <—<-<—<—<—<—<—<—<—<— <— —<-7/<— Ex. Ditch o � 100.x• N 0°54'40"E O C 0 X tmD 0_ w /(O L N o ` m a wm >�� c mm m m p 0 ° ms D w CO m vzm m o K CD O X K v ' co W m o 3' r Q m-i5 mU o = > m m> ca x c f 00 D7 c ' i D -1 X 07,n-qt v CO j m Cr i XI < N -i <o CD fp � m * CD cD � m m v O v o o a; CD < z Oa w CD w m fir o y m 0 ii 0 " 07 W 0 Z / m 0' m ro 1 4 X. n m m ?‹ o ?0) 18 m " N o b ❑ . Q 0 n d b m --I m Z c N n v 3 'p m ',�� 5• 0 7 � �co ® X o j— Ex. Upper Deck Ex. Upper Deck �� om ° .. n T N D 0 co O X o c) N X X N �D O>Q.7 tD CAD O" O a X 7 0.0cO g-0. = ?iv 3 n o 0_h(OD 2 Q' (D a n Ex.8'x 28' Addition (+Qi SS o— __Q 1oo.00' , 4C test' S O°54'40"W S V1 dyla rt W3‘144 e oP'�' o'°tt NO°I o i \i O5e-1ph -b I —bR-ne. q J? 4 00 9 -1 LID , I ° MAY 7 2 ,014 ACC=RISER EL S- 3 T L .1 n Taf-1-1 . MINIM (¢1111 ma SOURCE min MN 11111It l - ALTER MIDDIERTS . sEWACC DISPOSAL DESIGN SEPTIC TANK -1 Approve oy� ctiort Date Trench Profile ( No Scale ) (See Notes For Details) Finish Grade ,� / o-• extile Filter Fabric Native Backfiil Inspection Po MA -- 4"ASTM 02729'P- End Trench nD" Box Finish Grad- 4"ASTM D2729 To Drainfield ■ - ASTM 3034 (:Solid) .' From Septic Tank- - ` o i 3/4"to 11/2" Clean Drainrock .:-:•:•:-:.:.:•:•:.:.:......-. 6"Min. Under Pipe aiii i-sA4A 'To X10 Of: V Way; ,4s. • + , b. 4,_N i o.:$ERNT PAUL ERICSEN.. IA te i-.E i\®1\ �.\A r\'�\'i\\'l.C�e. r-r-rs 6, 11 C 5_R_iit ,;,i4 � b y/� , .1st W^.�,�, :',,,,. SEWAGE DISPOSAL DESIGN 1 uctio pr " `Op 14..4► Approved f �r C,o ry4k ice`' 0259 '.i4 Joseph Di Be Date 1�e0! gyp?BERNT PAUL ERICSEN h 938400821 i C a c ii DE ,, *ER 1 ...",►w..►....a....wr►mwAo 1'='r1 e. 11-1.. 4'"i—14 Project Description Decommission existing tank ( which was found to be leaking ) See SOM77 — 33. Install "New" Septic Tank. Septic Tank Install 1000 gallon two compartment septic tank. Install water tight risers to grade on all tank lid openings. Install outlet baffle filter ( Orenco FTiP 0418 — W ) or equivalent. Tank to be set on 6" of "Pea Gravel". Fill with water prior to "Designers" inspection. Transport Line Reconnect to existing sewer pipe from building @2% minimum grade and reconnect to existing pipe to "D" box @ 1% min. Inspections Designer needs to be contacted for a pre-construction meeting prior to construction to discuss details and to set up schedule for inspections. Designer is responsible for submitting "Record" drawing, and must be called prior to backfilling system. General Construction Notes 1. The work described herein consists of construction of an on-site wastewater system. 2. The contractor shall be knowledgeable and experienced in the construction of this type of wastewater system and shall hold a valid certificate from Jefferson County Division of Environmental Health. "Approved" septic plans must be on site during construction. 3. If during the installation of the system the contractor finds soil conditions that may lead to premature failure of the system, construction shall be terminated immediately and the designer notified. Such soil conditions may include groundwater, fill, clay, highly compacted soil, bedrock or excessively permeable soils. 1. Any inconsistencies, errors, or omissions that, in the opinion of the installer, would compromise the quality of the wastewater system shall be reported to the designer prior to construction. 1. Backfill in traffic areas shall be pitrun gravel and compacted. All gravity pipe shall conform to ASTM D 3034. All gravity and transport pipe shall be bedded, using native or imported material free of rocks, debris and sharp MAY 1 2 2014 objects. 2. All exposed soil shall be seeded and mulched prior to the final inspection. Seed shall be spread at an approximate rate of 10 lbs. per 5,000 sq. ft. 3. The installer shall be responsible for constructing the system according to plans and conditions of permit and shall be responsible for its proper operation and function for one year. The owner shall be responsible for operating and maintaining the wastewater system in accordance with WAC 246-272A-0270. 4. Any changes, substitutions, or deviation from these plans shall be approved by the designer and by the Jefferson County Environmental Health Department. 5. The installer shall grade to divert all surface water runoff away from tanks and drainfield/reserve areas. 6. The bottom of the trench or bed may be inspected by the designer prior to placing drain rock and shall not exceed +/- '/s" from level. Place filter fabric over drain rock prior to backfilling. 7. Setbacks to all known water lines shall be a minimum of 10'. No crossing of water lines with any septic component shall be allowed, except as included in septic design approved by Jefferson County Health Department. 8. Setback from the house foundation wall shall be 10' minimum to drainfield, 5' minimum to tanks and 2' minimum to non-perforated sewer pipes. Water saving appliances, fixtures, and practices are to be used. 9. The septic and pump tanks, drainfield and reserve areas are to be protected from vehicular traffic or mechanical disturbance. 10. The designer is to provide the as-built and letter of certification. 11. This system has been designed in accordance with WAC 246-272-A- 0270 and the most current Department of Health "Recommended Standards and Guidelines for Pressure Distribution Systems," and has been approved by the Jefferson County Health Department. Nevertheless, negligence or improper action on the part of the users could result in the premature failure or malfunction of the system or its components.